India’s missing girls: A tale of healthcare neglect faced by girls

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Two months ago an eight-day-old baby girl was abandoned at a Primary Health Centre (PHC) in Morna village of Western Uttar Pradesh. The PHC in-charge immediately shifted her to the district government Hospital, 25 kilometres away, in the town of Muzaffarnagar, where the infant held her own, even though she was terribly underweight.

I was in the area when this report appeared in the local media, and decided to find out whether incidents like these were common.

In Morna, the PHC was crowded with men and women with young boys, but almost no girls. The medical officer was shockingly outspoken. “Cases like these are infrequent. But the truth is that daughters here are treated a burden. Men only want sons who will farm the land and can use their lathis (baton) in a fight, while they can sit back and smoke their hookahs. Daughters are only an expense.”

Not surprisingly, all the men in the room agreed with the doctor, except for one who said that young people in his village were changing and they no longer considered the birth of a daughter as inauspicious.

His voice raised some hope for the girls in the region, recently portrayed as victims of love jihad. Here the real threat to their lives comes from their own families. For instance in 2014, the six districts of Western UP -- Muzaffarnagar, Meerut, Bijnor, Saharanpur, Baghpat and Shamli together accounted for 37 maternal deaths per day and the lowest child sex ratio (0-6) in the state.

Professor Ravinder Kaur of the Department of Humanities and Social Sciences, IIT Delhi, believes that while preference to have a son has always been prevalent in Indian society, it rarely translated into discrimination against the daughter.

A disturbing trend which is now beginning to show is that the number of girls for every 1000 boys in the 0-4 year age group has declined from 914 to 909 between 2007 and 2013.

So what form does this prejudice take? The most common is medical neglect. And the All India National Family Health Survey (NFHS) exposes this reality. Boys receive prompt medical attention than girls during an illness and are better provided by their guardians to cope with its fallout.

Boys with diarrhoea are 7% more likely to be taken to a health facility than girls

Among last-born children, boys are 11% more likely to be breast-fed

And the proportion of fully immunised boys is 4% higher

Armed with these statistics, I visited two hospitals in the town of Meerut, and found the situation was far worse, the prejudice against the girl child ran much deeper.

At the privately run Chiranjeev Clinic for children, Dr Neeraj Khamboj said that three-year-old Sarita suffering from pneumonia had come to his clinic the previous day. After examining her, he advised the girl’s parents to hospitalise Sarita as her condition was critical, instead they took her home before any proper investigations could be done or line of treatment decided.

“If she had been admitted, they would have had to incur an expenditure. But if it had been their son, the parents would have never left. We had to note down in Sarita’s record, that she was taken away against medical advice,” said Dr. Khamboj

According to Dr Khamboj, girls who require prolonged medical treatment are less likely to survive than boys.

Dr Amit Upadhyaya, Head of Pediatrics at the Lala Lajpat Rai Government Medical College, confirms the bias against the female child. “More boys are vaccinated than girls, even though it is free. Because unlike the Pulse Polio programme, where a health worker goes from home to home to administer the drops, the children have to be brought to a medical facility for these shots. Parents are willing to make the effort for their sons, but not their daughters.”

That's why even though more new born girls survive than boys as they have stronger constitutions, the trend is reversed at the post neo-natal stage as the following figures indicate.

Neonatal mortality (1 to 28 days) 40.9 male v/s 36.8 female

Post-neonatal mortality (28 days to 1 year) 15.4 male v/s 20.9 female

Under 5 mortality, 69.7 male v/s 79.2 female

Most doctors say there is a tendency to give girls less food than boys, which inevitably leads to malnourishment, low immunity against infections and sometimes death.

Advocate and Women’s Rights activist, Kirti Singh sums up the situation perfectly -- “It's interesting that while we have thought of laws to deal with sex determination, we have no legal framework for addressing the persistent neglect, discrimination and violation girls face in their homes after being born. There are some provisions in the Juvenile Justice Act which say that if a child is abandoned then the Juvenile Justice Board will step in and place him or her protective care, but there is nothing at all which states that a child who is being ill-treated at home can be rescued.”

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